isosorbide mononitrate vs dinitrate conversion

The patient should be sitting immediately after sublingual or intrabuccal administration. Your doctor may increase your dose as needed. Isosorbide mononitrate is a medicine important in treating heart-related chest pain, heart failure, and oesophagal spasms. Although a . Isosorbide dinitrate is a medication important in treating heart failure, oesophagal spasms, and treating chest pain that comes from not enough blood flow to the heart. The possibility of developing orthostatic hypotension in elderly patients, The possibility of developing severe hypotension when combined with Phosphodiesterase(PDE) inhibitors in male patients, The development of tolerance during chronic isosorbide therapy and drug-free intervals, The possibility of developing anginal pain during drug-free intervals. Isosorbide Mononitrate vs Isosorbide Dinitratein Tabular Form Apart from limiting alcohol, you can eat and drink normally while you are taking isosorbide mononitrate or dinitrate. Serious adverse reactions to the organic nitrates and nitrites are uncommon and their adverse effects mainly involve the CNS and cardiovascular system. Your doctor will be the best person to decide what treatment is best for you. Tell your doctor that you're taking isosorbide mononitrate or dinitrate if you're going to be put to sleep (using general anaesthesia), or you're having any kind of major operation. Roman S, Kahrilas PJ. The patent was approved, leading to the production of BiDil, a single-pill equivalent to the generic H-ISDN. In conclusion, in patients with heart failure with a preserved ejection fraction, the receipt of isosorbide mononitrate, as compared with placebo, decreased daily activity levels. Isosorbide use requires caution in the following conditions: Generally, isosorbide does not need any monitoring. Dr. Rick Koch answered. They are also given with other medicines to treat heart failure including left ventricular failure. http://creativecommons.org/licenses/by-nc-nd/4.0/ Terms of Use and Privacy Policy: Legal. It usually happens because your arteries have become hardened and narrowed. This helps your heart to work properly and reduces chest pain. Each Isosorbide mononitrate extended-release tablet, for oral administration contains 30 mg, 60 mg or 120 mg of ISMN. Isosorbide decreases the preload and worsens the right ventricular output causing severe hypotension. ISDN allows you to exercise for up to eight hours. The route of administration for this medicine is oral, but it can be taken under the tongue as well. Isosorbide mononitrate or dinitrate is not likely to affect your sex life. ~}xp%0Vg^r3WT_a-~qvQD]dvo{,Z@${ssJC j(2GW`_? In patients with hypertrophic cardiomyopathy, isosorbide decreases the preload and, hence, the left ventricular volume, worseningleft ventricular outflow tract obstruction.[11]. In addition . Created for people with ongoing healthcare needs but benefits everyone. x][7~_cNv2}LN ` 8ql'O_}U%zwZ]U{_U]V?/*S~[~|^bn[zHsxuy][^,;}.oO^mweU^.Wn>{l .6=(r#n*xW7| J{{or`}|4^r May increase dosage to 120 mg (as a single 120-mg tablet or as two 60-mg tablets) once daily after several days; 240-mg dosages rarely needed. If you take isosorbide mononitrate or dinitrate 2 or 3 times a day, your doctor or pharmacist will explain how to space out your doses. The elimination half-life of isosorbide dinitrate is about 1 hour, and the excretion occurs through the kidney. Both isosorbide mononitrate and dinitrate are only available on prescription. Invasive monitoring of central fluid volume is advised in renal failure and congestive heart failure patients. Furthermore, there can be some severe effects as well, which include low blood pressure when exposed to PDE5 inhibitors, e.g. What isIsosorbide Dinitrate You could be having a serious allergic reaction and may need immediate treatment in hospital. Parker JD, Parker JO. Tight, light-resistant containers at room temperature (25C); do not expose to extremes in temperature. Development of a Combination Product. Isosorbide mononitrate differs from isosorbide dinitrate according to the number of nitro groups per molecule. isosorbide dinitrate (ISDN) isosorbide mononitrate (isosorbide-5-mononitrate; ISMN) . Orang awam lebih mengenalnya dengan penyakit angin . Isosorbide is excreted primarily through the kidney as glucuronide derivatives of the de-nitrated metabolite. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Not known whether geriatric patients respond differently than younger patients. Headache, the most frequent adverse effect, may be severe (persistent or transient) and is perceived as a pulsating, throbbing sensation; frequent early in therapy, usually diminishes rapidly, and may disappear within several days to weeks of continuous therapy. If you stop taking isosorbide mononitrate or isosorbide dinitrate, your symptoms may get worse. (isosorbide dinitrate) Sustained Release Capsules 40 mg . Oral use. If you have been taking it regularly and you stop taking it, your angina symptoms or heart failure may get worse. [2] It is taken by mouth. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patient's requirements and response; use the smallest effective dosage. Intermediate: Release is Isosorbide Dinitrate while mono nitrate is extended.Immediate release is nitro stat. After therapeutic doses, cardiac output may increase transiently and then decrease. In heart failure, isosorbide mononitrate and dinitrate relaxes the blood vessels, making it easier for your heart to pump blood around your body. Swallow the tablets or capsules whole with a drink of water. Excretion of isosorbide mononitrate occurs through kidneys. Caution if used in nursing women. Nitrates are used to treat and prevent angina. When isosorbide dinitrate is used in fixed combination with hydralazine, consider the cautions, precautions, and contraindications associated with hydralazine. 30% of the dose is available for immediate release and the remaining 70% is gradually released over time. Isosorbide dinitrate is effective by mouth for the prophylaxis and treatment of angina; although the effect is slower in onset, it may persist for several hours. Isosorbide mononitrate and dinitrate comes as tablets, or capsules. Moreover, isosorbide mononitrate has a bioavailability of about 95% while isosorbide dinitrate has a bioavailability of about 25%. Titrate dosages to levels similar to those recommended for the fixed-combination preparation and administer both drugs at least 3 times daily. Isosorbide dinitrate was synthesized in the United States in the 1950s by Harris and colleagues. Other adverse effects can be due to the reflex activity of the sympathetic nervous system due to vasodilation. Z L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. Treatment of congestive heart failure. Changing positions slowly can help lessen dizziness. [10]The MLCK, along with the unphosphorylated myosin light chain, causes the myosin head to detach from the actin component of the smooth muscle, resulting in smooth muscle relaxation and causing vasodilation. Bortolotti M, Coccia G, Brunelli F, Sarti P, Mazza M, Bagnato F, Barbara L. Isosorbide dinitrate or nifedipine: which is preferable in the medical therapy of achalasia? This activity will highlight the mechanism of action, adverse event profile, off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, and relevant interactions pertinent to the health care team members in managing patients with angina pectoris due to coronary artery disease and related conditions. They differ from each other according to their applications and properties. Figure 02: The Chemical Structure of Isosorbide Dinitrate. Fung HL. With a mind rooted firmly to basic principals of chemistry and passion for ever evolving field of industrial chemistry, she is keenly interested to be a true companion for those who seek knowledge in the subject of chemistry. Isosorbide mononitrate conventional tablets, peak: 0.51 hour. Tight, light-resistant containers at 25C; may be exposed to 1530C. Rapid titration (over 35 days) may be possible; however, slower titration may be needed due to adverse effects. Isosorbide dinitrate also comes as an injection or drip (infusion), which is given in hospital. But Its maximal effect is seen in venous capacitance vessels. Isosorbide dinitrate is contraindicated in patients with shock or marked low blood pressure. After several days, dosage may be increased to 120 mg (given as single 120-mg tablet or two 60-mg tablets) once daily. Caution in volume depletion or preexisting hypotension. Isosorbide dinitrate, sublingual - 2.5 to 10 mg (duration of action - 10 to 60 minutes), Isosorbide dinitrate, oral - 10 to 40 mg 3 times a day (duration of action - 4 to 6 hours), Isosorbide dinitrate, spray - 1.25 mg per dose, Isosorbide dinitrate, oral sustained-release capsules/tablets - 40 mg,14 hours apart (duration of action:12 to 14 hours), Isosorbide mononitrate, oral - 20 mg twice daily, 7 hours apart (duration of action - 6 to 10 hours), Isosorbide mononitrate, oral sustained-release tablets - 30 to 120 mg daily, A fixed-dose combination of isosorbide dinitrate (20 mg) and hydralazine hydrochloride (37.5 mg) has received approval for use in treating heart failure in African-Americans, Orthostatic hypotension (0.1 to 10 percent), Concomitant use of isosorbide with PDE inhibitors such as sildenafil and tadalafil, Concomitant use of isosorbide with riociguat, a soluble guanylate cyclase stimulator used for the treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension, Elderly patients with autonomic dysfunction due to a high risk of orthostatic hypotension, Patients on diuretics will be volume depleted and can develop severe hypotension, Patients who are taking other vasodilators due to the risk of severe hypotension, Patients who have low blood pressure and low heart rate, Patients who are on chronic diuretic therapy, Elderly patients with underlying autonomic dysfunction, Patients with right ventricular infarction who are preload sensitive, Volume-depleted patients, e.g.,from chronic diarrhea and vomiting, Patients who are taking other types of vasodilators, 12-hour drug-free interval with 40 mg dose, 18-hour drug-free interval with 80 mg dose, 24-hour drug-free interval with 120 mg dose. No specific dosage recommendations for hepatic impairment. . Imdur (isosorbide mononitrate) Extended Release and Ranexa (ranolazine) are indicated for the prevention of angina pectoris. Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation. Isosorbide mononitrate and dinitrate are types of heart medicine called nitrates. Warn all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potential consequences of taking the drugs within close proximity (e.g., within 24 hours of sildenafil; possibly more prolonged periods of risk with longer-acting PDE inhibitors) of taking a nitrate- or nitrite-containing preparation. If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor. Maximum: 80 mg 3 times/day. May cause a burning or tingling sensation when administered sublingually. May cause blurred vision and should be discontinued if this symptom occurs. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Nitrates work by widening blood vessels (veins and arteries). The most common brand names of this medication are Monoket and Imdur. 4, 7 Isosorbide mononitrate is an active metabolite of isosorbide dinitrate. (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be . Answers. Isosorbide dinitrate in fixed combination with hydralazine hydrochloride: About 2 hours. Angina and heart failure is a warning sign that you are at risk of serious problems such as heart attacks and strokes. Will I need to stop taking it before surgery or before tests? In addition, the elimination time ofisosorbide mononitrate is about 5 hours whereasthe elimination time ofisosorbide dinitrate is 1 hour. Speak to your doctor or a pharmacist if you want to breastfeed while taking isosorbide mononitrate or dinitrate. It is not suitable to take to treat an angina attack - you should always carry with you a short-acting nitrate, such as glyceryl trinitrate (GTN), for if you get angina pain. Blood returning from the body in the veins must be pumped by . Prolonged use of oral nitrates has been associated with the development of tolerance to the hemodynamic and antianginal effects and possibly with cross-tolerance to sublingual nitrates. Though methemoglobinemia is a rare complication, patients more susceptible to developing methemoglobinemia require close monitoring for signs and symptoms. (dinitrate conventional tablets) two to three times daily. 2. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 3.1 h) than when misoprostol-oxytocin (11.9 3.1 h) was used. Initially, isosorbide dinitrate conventional tablets (e.g., Isordil Titradose) 520 mg administered 23 times daily, followed by maintenance dosage of 1040 mg administered 23 times daily (some patients may require higher dosages). Isosorbide mononitrate vs dinitrate dose conversion Isosorbide mononitrate is usedto treat chest pain (angina) in adults and children above six years of age. You do not need to avoid playing sports due to taking isosorbide mononitrate or dinitrate. The challenges of isosorbide therapy are drug interactions, adverse effects, and the development of tolerance during chronic isosorbide therapy. The venodilation results in peripheral pooling of blood and arteriolar dilation, lowering systemic vascular resistance (afterload) and lowering blood pressure. Importance of warning all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potentially severe and life-threatening hemodynamic consequences of taking the drugs within close proximity (e.g., within 24 hours of sildenafil; possibly more prolonged periods of risk with longer-acting PDE inhibitors) of taking a nitrate- or nitrite-containing preparation. Sisenwine SF, Ruelius HW. Clinicians unfamiliar with their patients drug history, especially those involved in emergency care (e.g., for presumed myocardial infarction or ischemia), should take a careful history so that concomitant use of organic nitrates or nitrites with selective PDE inhibitors can be avoided. Isosorbide mononitrate (Monoket) is good for a specific type of chest pain (called angina), but it can cause headaches or dizziness after you take it. [7], Isosorbide helps alleviate the symptoms of angina byincreasing the myocardial blood flow and decreasing the myocardial oxygen demand. Paradoxical bradycardia and angina exacerbation may accompany hypotension. However, if you have angina you may have a higher risk of having a heart attack or stroke. The major route of administration for this drug is oral administration. The methemoglobinemia associated with isosorbide toxicity is manageable by supportive care and cessation of isosorbide. Concomitant use of isosorbide with PDE inhibitors will cause increased cGMP, resulting in life-threatening hypotension. Each dilatrate Copyright 2023, Selected Revisions February 7, 2017. It's important that you keep taking your medicine to keep you well. Compare the Difference Between Similar Terms. Target: 40 mg 3 times/day. Prescription only. Do not use extended-release isosorbide dinitrate preparations or any isosorbide mononitrate preparation to abort an acute anginal episode or for acute relief of angina or in the prophylactic management in situations likely to provoke angina attacks; onset is not sufficiently rapid. Isosorbide dinitrate-hydralazine combination therapy in African Americans with heart failure. sildenafil. Administer sublingually, intrabuccally, or orally. mononitrate, isomannide mononitrate, isosorbide-2-mononitrate, and 5-ISMN. If relief is not attained after a single dose during an acute attack, may give additional doses at 5- to 10-minute intervals; give no more than 3 doses in a 15- to 30-minute period. The isosorbide mononitrate extended-release tablet is an oral extended-release formulation of ISMN, the major active metabolite of isosorbide dinitrate; most of the clinical activity of the dinitrate is attributable to the mononitrate. Isosorbide mononitrate has one nirate group and isosorbide dinatrate has 2 nitro groups. do Nascimento TS, Pereira RO, de Mello HL, Costa J. Methemoglobinemia: from diagnosis to treatment. Controlled medication release is achieved using the Durules principle of insoluble matrix embedding.Data from randomised double-blind trials show that IMD 60mg once daily (the most widely studied dosage) has significant antianginal and anti-ischaemic effects compared . <>stream daily and increasing to 40 mg three times daily as necessary, given at 8 AM, 1 PM, and 6 PM), isosorbide mononitrate (starting at 30 mg/day in the morning and increasing to 120 mg/day as necessary), or a transdermal. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Divakaran S, Loscalzo J. Active Ingredient (s) APO- Isosorbide Mononitrate. The trade name of this drug is Isordil. It is in the nitrate class of drugs. For example, if you are taking standard tablets twice a day, they may tell you to take 1 dose in the morning at 8am and the second dose in the afternoon at 2pm (leaving a gap of 6 hours between your first and second dose). What intervals in oral therapy of isosorbide dinitrate in various doses are sufficient to prevent nitrate tolerance? Your email address will not be published. The medicine lowers blood pressure by causing veins to narrow and makes the heart more sensitive to the blood pressure (usually a very high blood pressure). The organic nitrates are vasodilators, active on both arteries and veins. Because of their hemodynamic profile, particularly beneficial in patients with left ventricular systolic dysfunction or heart failure. (adsbygoogle = window.adsbygoogle || []).push({}); Copyright 2010-2018 Difference Between. The most common side effects of isosorbide dinitrate include headache, lightheadedness when standing, and blurred vision. Usually you will take isosorbide mononitrate and dinitrate for a long time, possibly for the rest of your life. Therecommended drug-free intervals for preventing the development of tolerance for oral sustained-release isosorbide dinitrate are as follows[27]: The patients should understand the possibility of developing anginal episodes during the drug-free interval. Nitrates in the management of acute coronary syndrome. Learn how we can help. Improved exercise capacity and differing arterial and venous tolerance during chronic isosorbide dinitrate therapy for congestive heart failure. According to pharmacokinetic data, the bioavailability of this drug is about 25% on average, and its metabolism occurs in the liver. The venous hypotension and the arterial hypovolemia of isosorbide overdose can be managed clinically by: There is currently no evidence of teratogenicity or carcinogenicity potential of isosorbide.[11]. How can lifestyle changes help the health of my heart? To reduce your risk of problems like these, it may help to: Page last reviewed: 1 July 2021 '~|4+TYG_X7b0-umj-&0=5Gf37{h73?}vQ8V:/-%c:y S`(0hIk i[j_ {?Mkpr | C+{wC7Rl q3fc(@L0h{a2V,9 y:et/!i!-U*cu6<63l^}W>8V26U;s:u;x=_pTm}FI6hR{AH &VH=0Xa Q@?gB kCRt)tmlx &>AwVqF+|UGFhGEV=AVofypRu"8F=bj Nitroglycerin is the fastest-working medicine to relieve chest pain, but make sure to sit down before taking it. Isosorbide mononitrate comes as standard tablets and slow-release (modified release) tablets and capsules. Long-acting nitrates. Isosorbide mononitrate: Metabolized principally in the liver, but unlike isosorbide dinitrate, does not undergo first-pass metabolism; metabolites appear to be pharmacologically inactive. include: Impaired nitroglycerin bioconversion to 1,2-glyceryl dinitrate with decreased formation of nitric oxide. Take any leftover tablets or capsules, and the packet or leaflet with you. Isosorbide mononitrate is an organic nitrate with vasodilating properties. This medication is commercially available in two forms: as an oral tablet both in extended-release and slow release. May decrease dosage to as little as of the fixed-combination tablet 3 times daily in patients who experience intolerable effects, but attempt to titrate dosage up once adverse effects subside. Or 30 to 60 mg (mononitrate extended-release tablets) once daily. [Updated 2022 Jul 3]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. It is in the nitrate class of drugs. The activity of isosorbide dinitrate may depend on the production of active metabolites, the most important . Is there any food or drink I need to avoid? Similarly, sustained or repeated oral administration of isosorbide dinitrate for the prophylaxis of angina does not improve the exercise duration as much with a single use (2 hours vs. 6 to 8 hours), in spite of much higher plasma concentration [21].Eccentric or asymmetric dosing is one way to circumvent this. There is no clear evidence that isosorbide mononitrate or dinitrate affects fertility in men or women. Combination of isosorbide dinitrate and hydralazine recommended by ACCF and AHA for self-identified black patients with NYHA class III or IV heart failure and reduced ejection fraction who are receiving optimal therapy with ACE inhibitors and -blockers, unless contraindicated. ever had an allergic reaction to isosorbide mononitrate or isosorbide dinitrate or any other medicine, any other heart problems, including a recent heart attack, any recent brain or head injuries or problems, 10mg, taken twice a day, up to a maximum dose of 120mg, split into smaller doses, 25mg to 60mg, up to a maximum dose of 120mg, taken once a day, 40mg, taken once or twice a day, up to a maximum dose of 60mg to 80mg, taken 2 or 3 times a day, 10mg to 20mg, taken 2 to 3 times a day, or 40mg, taken twice a day, up to a maximum dose of 120mg daily, split into smaller doses, 40mg to 160mg, taken daily, up to a maximum dose of 240mg a day, split into divided doses, your mouth (lips, tongue or gums), face or skin start to look blue or grey. You can take either tablets or capsules with or without food. 4. PI. Talk to your doctor or pharmacist if these side effects bother you or last more than a few days: Serious side effects after taking isosorbide mononitrate and dinitrate are rare. Treatment effect. If you have darker skin your gums or the skin around your eyes may turn blue or grey these are signs of low oxygen levels in your body, your heart starts beating much faster or slower than usual, you get chest pain that is different or worse than your usual angina pain, you get severe pain in your eye, headache, blurred vision or you suddenly go blind in one eye these could be signs of acute angle closure glaucoma, you get a skin rash that may include itchy, red, swollen, blistered or peeling skin, your mouth, face, lips, tongue or throat start swelling, medicines for erection problems including, calcium channel blockers to relax the arteries, increasing blood supply to the heart muscle, build up your activity level gradually and take regular breaks, keep your GTN tablets or spray with you in case you need them, use your tablets or spray before starting exercise, if you need to. Plasma concentrations and urinary excretion of isosorbide dinitrate and its metabolites in the dog. The following infographic presents thedifference between isosorbide mononitrate and isosorbide dinitrate in tabular form for side by side comparison. Conventional measures in the management of angina pectoris are aimed at reducing the frequency, duration, and severity of attacks, and include coronary risk reduction (e.g., discontinuance of smoking, weight control, antilipemic strategies), rest, avoidance of precipitating circumstances (e.g., eating heavy meals, getting emotionally upset, performing strenuous exercise, exposure to cold air) and, if possible, treatment of the underlying cause. 1 0 obj Do not exceed daily Dilatrate-SR dosages of 160 mg (4 capsules). Nurses and general practitioners should ensure that isosorbide therapy is not an option for patients with erectile dysfunction by taking phosphodiesterase (PDE) inhibitors. Importance of informing patients of other important precautionary information. % Mnzel T, Steven S, Daiber A. Organic nitrates: update on mechanisms underlying vasodilation, tolerance and endothelial dysfunction. Christiansen I, Iversen HK, Olesen J. Headache characteristics during the development of tolerance to nitrates: pathophysiological implications. Summarize the importance of collaboration and communication amongst the interprofessional team to enhance care delivery and improve outcomes for patients with angina pectoris receiving isosorbide. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Isosorbide dinitrate used in fixed combination with hydralazine (BiDil) as adjunct to standard therapy for the treatment of heart failure in self-identified black patients to improve survival, decrease rate of hospitalization for worsened heart failure, and improve patient-reported functional status. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. This study describes the relationship between nitroglycerin, isosorbide dinitrate, sodium nitroprusside, and carbonic anhydrase I, as well as the involvement of this carbonic anhydrase I in vasodilation. After oral administration, isosorbide dinitrate undergoes an extensive first-pass effect in the liver, reducing the oral bioavailability to 20 percent. Both isosorbide mononitrate and isosorbide dinitrate are broken down into nitrates in the body. For example, if you are taking standard tablets twice a day, they may tell you to take 1 dose in the morning at 8am and the second dose in the afternoon at 2pm (leaving a gap of 6 hours between your first and . This is because it can lower your blood pressure too much when combined with some anaesthetics. Your doctor may advise you to stop taking isosorbide mononitrate or dinitrate before surgery. Talk to your doctor if you are having problems with your sex life. Isosorbide mononitrate By Vaccinationist Own work (Public Domain) via Commons Wikimedia If you are trying to get pregnant, talk to your doctor. Importance of consulting clinician if headache continues with repeated dosing. They are similar medicines that work in the same way, but the doses are different so you'll need to take the type that you're prescribed. After oral administration, isosorbide mononitrate EL has a quick onset of action (30 minutes) and effects are evident for . Importance of informing patients receiving isosorbide dinitrate in fixed combination with hydralazine that inadequate fluid intake or excessive fluid loss due to diarrhea, vomiting, or perspiration may result in excessive hypotension, possibly leading to lightheadedness or syncope; if syncope occurs, discontinue treatment and notify clinician immediately. Take the dose in the morning right after you wake up. <>>> Required fields are marked *. This medicine is particularly used in heart failure due to the ability of systolic dysfunction in combination with hydralazine. The key difference between isosorbide mononitrate and isosorbide dinitrate is that isosorbide mononitrate is primarily used in the management of chronic stable angina, whereas isosorbide dinitrate is recommended for heart failure. Isosorbide mononitrate helps to prevent angina chest pain from developing. Isosorbide dinitrate has been used effectively for diffuse esophageal spasm [off-label] without gastroesophageal reflux to relieve pain, dysphagia, and spasm. Showing results for nitrates-in-the-. Drinking alcohol can increase the effects of isosorbide mononitrate and dinitrate.